The best way to treat depression is not to get it.
When our culture is confronted with problems, it often seems that we tackle the issue in a backwards fashion. For example,
we do a better job at filtering the water we draw than we do filtering the wastes we put into the water source. In medicine,
we spend a quarter of a million dollars giving someone triple bypass surgery rather than spend a fraction of that amount on
encouraging that person to not eat bacon and eggs every morning.
In other words, reacting to negative events rather than promoting positive ones seems to be the way we behave as a species
even though intuitively the opposite approach makes more sense.
There is small but significant movement to adopt the opposite, more intuitive approach in the field of mental health. Although
research into the treatment of depression and other mental illnesses is a major enterprise for researchers and pharmaceutical
companies, some psychologists are directing their research efforts at the nature and causes of happiness. The questions are
intrinsically interesting, but the therapeutic rationale is that maximizing happiness will result in a reduction in depression
and other mental illnesses.
Called “positive psychology” and founded by Dr. Martin Seligman, a past president of the American Psychological Association,
the movement focuses on the study of positive emotions, identifying strengths of character and healthy institutions. Although
the field is relatively new, it has grown out of cognitive behavioural therapy (CBT), a proven psychological technique designed
to change behaviour as a means to improve mental states. Like CBT, much of the research shows that positive psychology therapy
can make adults happier and more satisfied, and give them a stronger sense of engagement and meaning in their lives.
Both CBT and positive psychology techniques are now being used with children. One such project is the Penn Resiliency Program
(PRP), a school-based intervention aiming to promote optimistic thinking as a buffer against stress, anxiety, and depression.
Catastrophizing is a way of thinking that involves magnification of an error or problem to unrealistic proportions. Cognitive
therapists have identified it as one of the cognitive distortions that can underlie depression and anxiety. “Kids often freak
out about events in their lives, catastophizing them into bigger problems than they actually are. We teach them to think logically
about what the most likely outcome is of a particular situation,” says Corrine Stoner, PRP project manager. The intervention
is running in several schools in the United States and is usually aimed at children nine to 14 years old. “We get them to
imagine the worst and best possible outcomes of an event, for example, a bad score on a test, to show them that the extremes
of a situation are not likely to happen.” Stone says using flawed internal language, some kids can go from failing a test
to homelessness and complete failure in adult life in only a few steps. “We get them to reason that this will not happen.
Then we imagine the most likely outcome and teach them techniques to solve the problem.”
With approximately twelve 90-minute sessions spread over several weeks, the program also teaches children social problem solving
skills, which often involves correcting the same misuse of internal language and catastrophizing. Of thirteen studies evaluating
PRP, ten have shown significantly reduced rates of symptoms of depression over students who did not do the program. These
effects have lasted about two years in most kids and are continuing as we continue to observe them. Moreover, the program
has been taught in both middle class and inner city schools, and in China, delivering similarly positive results: fewer symptoms
of depression and pessimism over time.
Depression and happiness opposites?
One of the questions these therapies raise is whether less depression translates into more happiness.
“Usually these relate but we don’t really know for sure,” says PRP co-director Jane Gillham, PhD and co-director of the Resiliency
Project. “The data showing that preventing depression boosts happiness is not always straightforward.” Gillham, who helped
create the PRP with Dr. Seligman, is delving further into the question with another school-based intervention
Currently running in high schools, this positive psychology initiative’s aim is to increase happiness rather than prevent
depression. The program is new and no data have yet been published, but Gillham is hopeful the initiative will show positive
results since much of the curriculum is modeled after similar and successful interventions done on adults.
This program focuses on the “three roots of happiness” that underpin positive psychology: the pleasant life, where you experience
a succession of pleasures; the good life, where you play your strengths and become engaged; and the meaningful life, where
you put your strengths at the service of something higher than yourself.
“The exercises the students perform address some aspects of this view of happiness. For example, there are savouring exercises
where the students learn to more actively enjoy pleasant activities such as listening to music or having a conversation.”
It is important to savour these pleasant activities since some pleasures can lose their effect, or can even become dangerous,
say in the case of alcohol or food, with repetition. In terms of the “good” life, Gillham gets the students fill out questionnaires
and try to identify what their personal strengths and values are. “They then write narrative about these strengths and share
them.” In this way, it is hoped that the teenagers can identify and do more of the activities that take advantage of these
strengths.
Adult research on strengths has shown when there is a match between a person's strength and their activity, people become
absorbed and immersed in that activity, giving them confidence and a sense of accomplishment. When this experience is optimized,
researchers say that people experience what has been recently coined as “flow”. “It is the pleasant sensation that time has
slowed or shifted because you are so engaged in an activity,’ says Gillham. While flow may not be easy to create at will,
most people have experienced this euphoric sensation. “There is a lot of power in just noting that it exists,” says Gillham.
“Most of the students have felt flow but have never really talked about it or consciously wondered how to do it more.”
According to Gillham, perhaps the most powerful part of the program is exercises on meaning. Following in-depth discussions
on the nature of meaning and an examination of what others have found to be meaningful, the students are asked to write a
journal on their own thoughts on the subject. “Often, we get them to do this with a parent. For ninth graders, this can be
a very powerful experience. It also provides a meaningful context for parents to interact with their children.” Gillham hopes
these exercises will encourage and guide the children to pursue as adults activities that they personally find meaningful
and steer them away from one they don’t.
The program also has an emphasis on developing emotional intelligence. “It’s the ability to understand other perspectives
and being able to get a sense of what other people are going through,” Gillham explains. “We already know that kids who score
well on emotional intelligence show fewer depressive symptoms.” Gillham also says that compassion and kindness are strongly
related to happiness.
In this regard, the students do “blessing exercises” writing out three good things that happened during the day. Students
also write and read out in person a “gratitude letter” to someone what has helped them.
Buddhism and happiness
Many researchers noticed that the connection between compassion and happiness has much in common with Buddhist ideas. Buddhist
thought, which is millennia old, stresses the importance of compassion. Buddhism is also in agreement with the positive psychology
notion that the most meaningful happiness comes from within rather than from external “pleasures”, which are transient and
can lead to excess and addiction. Psychologists, neuroscientist and others have taken note and a formal exchange of ideas
has begun.
Citing, among other things, Buddhist notions of reincarnation as being incompatible with science, not all psychological and
brain science researchers agree this exchange is useful. However, many scientists in the field disagree. Last year, the Dalai
Lama was invited to give a lecture at the annual meeting of the Society for Neuroscience, the world's largest gathering of
brain scientists.
While these researchers agree that science can be informed by Buddhism, the relationship is reciprocal. “Empirical evidence
should triumph over scriptural authority, no matter how deeply venerated a scripture may be,” the Dalai Lama, told the audience
at the neuroscience meeting.
That Buddhism ends up having so much in common with psychology and other sciences of the mind was not a surprise to everyone.
A similar East-West meeting of spirituality and science has already occurred and continues to evolve. When 20th century discoveries in physics replaced a classical, clockwork view of reality, some very large questions about the nature
of the universe and humanity’s place in it were created. Physicist Fritjof Capra’s 1975 bestseller, The Tao of Physics: An Exploration of the Parallels between Modern Physics and Eastern Mysticism is a useful exploration of this convergence and the questions it raises.
In the same way, Buddhism and modern positive psychology share some common perspectives on experience: happiness depends mainly
on our emotions and thinking rather than external forces. The Dalai Lama says “Happiness is not something ready made. It comes
from your own actions.” In turn, modern psychological research shows that people who win the lottery return to their previous
happiness level one year later as do, perhaps counter-intuitively, people who suffer a permanently disabling injury.
What’s next in school-age happiness interventions
Gillham says that it may be three years before data are published on the positive psychology initiative. Meanwhile, the Penn
Resiliency Project continues to expand on and publish its encouraging conclusions in the science journals, including, ironically,
The Journal of Abnormal Child Psychology. Gillham wonders at what age it might be best to begin these types of interventions.
“A big part of the process is stepping back and thinking about your thinking. There’s a lower age limit to this ability. At
the same time, some of the behavioural elements of the program could be taught a lot earlier.”
Also in the longer term, “we want to put the resiliency program and the positive psychology program together,” says Gillham.
“We like focusing on positive strengths but we also think the coping and resiliency skills are useful for students in a day
to day kind of way.”
Jonathan Link
Medical writer/editor
AboutKidsHealth
For more information:
http://www.ppc.sas.upenn.edu/
http://www.authentichappiness.sas.upenn.edu/
